86 CASES OF ADDISONS-DISEASE

OBJECTIVES Since there have been no recent reviews of Addison's diseas e, we have undertaken a retrospective case-notes review of all identif iable cases in Nottingham to define the prevalence, incidence and caus es of Addison's disease. We have also reviewed the criteria for interp retation of the short Synacthen test in diagnosis. DESIGN A retrospect ive study of all patients coded for the diagnosis and admitted to Nott ingham's hospitals between I April 1987 and 31 March 1993, identified by the hospital Information Services. PATIENTS A total of 86 cases wer e identifiable of whom 66 were still alive and living in the town. RES ULTS AND CONCLUSIONS The calculated prevalence was 110 per million pop ulation. The cause was attributed to autoimmune destruction of the adr enal cortex in 81 (93%). There were two cases of metastatic malignancy and three unrelated cases of late onset adrenoleukodystrophy, but non e were attributable to tuberculosis. Twenty-one new cases were diagnos ed between 1987 and 1993. The calculated incidence was 5.6 per million per annum. The biochemical basis of the diagnosis was reviewed in the se 21 patients and as a result firm criteria are suggested for the int erpretation of the short Synacthen test; criteria for normality being baseline cortisol >250 and 30 minute peak >600 nmol/l, taking into acc ount clinical circumstances.